NSAIDS for horse – Bute, Banamine®, and Equioxx®


There are plenty of times in any horse owner’s life that they will provide pain relief for their horse. Bute, Banamine®, and Equioxx® are fairly common options that you will come across.


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A quick disclaimer about horses and NSAIDS!


  • There’s a lot of “just give this” and “just give that” information on the internet. If your horse is ever in pain – your vet should be the first call. Please don’t give a medication willy-nilly. Giving meds before an exam hampers your vet’s ability to make a correct diagnosis and assess the severity of a situation. There are plenty of colics and hoof issues that seem minor and mild, but end up in surgery or with chronic lameness. It’s just not worth it. Let your vet decide if you should give meds before an exam.


  • However, it is absolutely worth it to know what these medications are, how they work, and how they can help your horse when prescribed by a vet. Knowledge is power!



jar of banamine and syringe

Keep all medications within the temperature ranges on the label, and check for expiration often. Do NOT give expired drugs or meds that have changed color.


How NSAIDs work in horses.


  • Non-steroidal anti-inflammatory drugs (NSAIDs) do just as they say, targeting swelling in the body, which then reduces pain. Acetaminophen and ibuprofen are examples for HUMANS. Horses have some options as well, in the form of bute (phenylbutazone), Banamine® (flunixin meglumine) and Equioxx® (firocoxib).


  • When tissue in a living creature is damaged or injured, the body creates hormones called prostaglandins at the site of the injury. Other hormones are secreted by glands, but these guys are site-specific.


  • Prostaglandins are involved with controlling swelling, regulating blood flow, making clots, and even inducing labor. They are not simply a hormone that causes pain and fever. There is even some evidence that prostaglandins create and help clear up inflammation. Sort of like the houseguest that comes uninvited but also makes the bed and loads the dishwasher before they go home.


  • But how do prostaglandins even come to be? The horse’s body has enzymes that produce these prostaglandins. Enzymes are proteins (usually) that act as chemical reaction facilitators. In the horse, as it relates to inflammation and prostaglandins, there are two types of COX enzymes at work. This is where NSAIDS do their business – in stopping these COX enzymes from making prostaglandins, and therefore targeting inflammation.


COX-1 and COX-2 enzymes in horses.


  • Let’s go a bit deeper with these COX enzymes. Most tissue in your horse makes COX-1 enzymes. The GI system and the kidneys use COX-1 enzymes to make prostaglandins that work on blood clotting. They also help protect the GI tract from damage. As we already know, the horse’s GI system is a precarious balance of many features, and disrupting the COX-1 enzymes is not something to be done without thought.


  • The COX-2 enzyme jumps into action when accidents happen. Injuries, along with long-term issues like arthritis, are in play here.


  • When it comes to COX-1 and COX-2, NSAIDS are different. Bute and Banamine® are termed non-selective, as they work on both types of enzymes. Equioxx® is termed selective, as it only works on the COX-2 enzymes. Most of the time. If you jack it up, it can also work on the COX-1 enzymes. You want to avoid this.


vet injecting a horse vein


Breaking it down even more – BUTE


  • This was the first NSAID I heard about decades ago. As it’s non-selective, the COX-1 and COX-2 enzymes are inhibited.


  • Bute is typically used in situations involving bone, muscle, and soft tissue pain or injury. Horses with arthritis pain may also benefit from bute, but the long-term effects are to be considered.


  • Oral paste or powder is common, and bute can be injected. If the vein is missed, bad things happen! The skin and tissue around the vein can die and peel away. There’s also the chance of a blood clot forming, which can complicate overall blood flow, cause bulges, and maybe even worse.


  • When your horse has an oral dose or injectable dose of bute via the vein, not muscle, much of it lands in your horse’s liver, kidneys, heart, lungs, and blood plasma. But what about the joint or muscle or soft tissue pain? Well, the inflammation in that area creates increased blood flow and fluid in the area, which delivers and pools the bute to the injury.


  • A note on feeding bute with food! When oral bute is mixed with food, this will slow things down, and your horse’s max pain relief takes a bit longer. Also, if your horse is dehydrated, this can affect how strong the dose is, and a regular dose can act like a double dose in your horse. More on that later!


  • Bute is also an NSAID that may be fine, in a tiny dose every few days, for an arthritic horse. This isn’t the case for some horses, and your vet definitely needs to weigh in on this. There are some better options out there for a horse that needs long-term pain relief.



bottle of horse medications


More about Banamine®


  • Banamine® is another non-selective pain reliever for horses.


  • When your vet pulls up, it’s likely that they have injectable Banamine® in their truck for easy administration. Intra-venous (IV) bute needs to be kept cool, and injectable Equioxx® is expensive. For these reasons, most Vets suggest Banamine® for colic situations. And for the record, Banamine® won’t actually treat colic, it’s only there to help your horse be more comfortable.


  • There is evidence that Banamine® helps to work against the resulting endotoxins that happen when some colics and GI issues become infected. As bacteria take over, they can release these endotoxins that quite literally can take over your horse, creating sepsis and laminitis and worse.


  • There’s tons of evidence that eye injuries are best helped with Banamine®, too. And let me be totally clear on this one – eye injuries are EXCRUCIATING. Like collapse in a ball and hope for a swift ending sort of pain.


  • One more bonus of Banamine®? It can reduce a horse’s fever. You will obviously need to be taking your horse’s temperature regularly to notice a fever in the first place. You will want to track how the fever goes up and down over time, as well.


  • Banamine® stays in the bloodstream for a shorter time than bute. But, the site of inflammation hoards Banamine®, so there is pain relief for quite a long time, sometimes as much as 12 – 24 hours in the musculoskeletal system. There’s also less floating around in the blood, which means the GI system and kidneys are not as threatened as with bute.


  • BUT – there is still the possibility of a toxic reaction. I have personally known one horse that died from kidney failure after receiving a HALF dose of Banamine® over a week.


  • If your vet has taught you how to administer Banamine®, it’s critically important that you NEVER, EVER inject it into the muscle or outside of the vein. A quick search engine survey of what can happen after muscular injection will reveal heartbreaking photos of neck muscles and tissue melting off. Sometimes, this will be fatal. If you are a beginner at injections, opt for Banamine® paste. You can give the IV form or Banamine® in the mouth, too, if that’s what you have.


  • The bottle is still labeled for IM use – do NOT do it. The risk of this infection is rare, but still exists. If you give Banamine® orally, it’s safer, just as quick to act, and no needles are involved!


equioxx bottle next to a bottle of liquid


And the new one – Equioxx®


  • This “new” NSAID is a selective inhibitor, only working on the COX-2 enzymes. This means the GI system and kidneys are typically not involved. HOWEVER – if you overdose your horse, bad things happen, including COX-1 getting involved and those GI benefits flying out the door.


  • Equioxx® is more expensive than bute and Banamine®. It’s also safer over time when used appropriately, and is usually a better option for a horse with an arthritis condition.


  • This is also a daily medication, instead of a twice daily dose. The tiny tablets are tasty, and most horses gobble them up as a treat. You can also get Equioxx® as a paste and an injectable.



three equioxx tables in a palm

ONE of these tiny tabs is dose of Equioxx. Never give more.


Risks and tidbits to know about the administration of NSAIDs to horses.


  • Just in case you missed this crazy important point, either before or in another article, please call your Vet before you administer any NSAID. Know your horse’s vital signs and if he may be dehydrated before you call your Vet. For more on vital signs, this article has you covered.


  • There are risks! NSAIDs can create kidney and liver damage as well as interfere with the GI system of your horse. Because bute is so powerful, many of the prostaglandins that benefit blood flow to the kidneys and GI system are blocked. Incidentally, bute also decreased mucus in the stomach, which is why gastric ulcers are also a concern.


  • A toxic reaction to NSAIDs are also possible. This can take days or weeks or longer to brew. You may see the reaction suddenly, or it can appear over time. Permanent and possible fatal liver toxicity can happen in some cases. In others, there may be diarrhea, colic, ulcers, going off food, and feeling generally bad. Some horses recover, others have chronic issues, some don’t make it.


  • Kidney damage is a real possibility also, as the NSAIDs reduce blood flow to the kidneys. This creates the opportunity for permanent kidney damage and cell death. Then you end up with malfunctioning kidneys. This is more likely to happen if your horse is dehydrated. Many horses with kidney issues devour water like mad and urinate like mad. Our good friend, bloodwork, can confirm these problems.


  • Right dorsal colitis is another life-threatening problem that can happen. Right dorsal colitis happens after ulcers develop in the large colon. This creates inflammation, pain, protein loss, diarrhea, colic like behavior, and unfortunately, organ failure and death. Markers, like protein loss, can be measured with bloodwork, just like liver and kidney function.


Please call your vet ASAP if your horse is on any of these medications and shows any of these signs.



vet listening to a horse's heart

Know how to take your horse’s vital signs and check for dehydration.


Make pain meds for your horse safer


  • Talk to your vet! There, I said it again.


  • Know how hydrated your horse is before you ever give a dose. Some colics, like impactions, are often the result of dehydration. Using some medications in a dehydrated horse will only make things worse.


  • To get the best measure of your horse’s hydration, aside from bloodwork, make sure you know his gums are slippery! Sticky, dull, dry, pasty, or crusty gums show dehydration. This is more accurate than a skin-tent test. A horse’s skin, just like a human’s skin, gets looser over time. What you see as a slow return to normal when you pull a bit of skin up may just be his wrinkled neck being old. Feel the gums!


  • If your vet gives you the go-ahead to start NSAIDs, opt for oral administration to eliminate any needle-related risks. It’s just as effective and works just as quickly. If you need to hide it in food, use the smallest amount of food possible or keep the paste version on hand.


  • Do not, for the love of all things horses, give more than the prescribed dose. I don’t mean the prescribed dose in general, I mean the prescribed dose for your horse at that very moment in time for his current situation. Same goes for more frequent dosing. If the pain meds wear off before the next dose, talk to your Vet about closing that gap with other options. Do not give meds early!


  • Don’t stack or overlap your NSAIDs. This only compounds potential problems. In some cases, you will need to wait a few days if you are switching from one type to another.


  • For show horses, check with your association’s rules on medications before competitions. Many have a “clearance” time before a show, during which your horse can’t receive the meds.


Thank you for coming to my talk about calling your vet!


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